Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long- and short-term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings.
BackgroundStress urinary incontinence (SUI) is a prevalent and costly condition which may be treated surgically or by physical therapy. The aim of this review was to systematically assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training (PFMT) performed alone and together with adjunctive therapies (eg biofeedback, electrical stimulation, vaginal cones) for the treatment of female SUI.MethodsAll major electronic sources of relevant information were systematically searched to identify peer-reviewed English language abstracts or papers published between 1995 and 2005. Randomised controlled trials (RCTs) and other study designs eg non-randomised trials, cohort studies, case series, were considered for this review in order to source all the available evidence relevant to clinical practice.Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion. Excluded were studies of women who were pregnant, immediately post-partum or with a diagnosis of mixed or urge incontinence. Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered.Two independent reviewers assessed the eligibility of each study, its level of evidence and the methodological quality. Due to the heterogeneity of study designs, the results are presented in narrative format.ResultsTwenty four studies, including 17 RCTs and seven non-RCTs, met the inclusion criteria. The methodological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence. This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for women with SUI with rates of 'cure' and 'cure/improvement' up to 73% and 97% respectively. The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care settings.ConclusionThere is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocols in subgroups of women and their effectiveness in clinical practice.
Purpose: To produce a composite evidence-based treatment algorithm for physiotherapy management of acute low back pain (LBP) using current, high-quality, English-language clinical guidelines. Methods: A systematic literature review of library databases and Internet search engines was performed to identify full-text, Englishlanguage clinical guidelines on the physiotherapy treatment of acute LBP. Quality assessment of the guidelines was undertaken by two independent reviewers using the AGREE instrument. Guideline recommendations were synthesized into interventions that were supported by strong, moderate or weak evidence. A composite clinical algorithm for physiotherapy management of acute LBP was developed. Results: Seven guidelines were included. Keeping active, written patient education, manipulation and referral to a spine specialist had strong supporting evidence for the management of acute non-radiating LBP. There were a large number of treatment options with moderate or inconclusive evidence. Bed rest and massage, as stand-alone treatments, had strong evidence of harm for patients with acute non-radiating LBP. Conclusions: Based on current evidence, a composite algorithm was constructed to assist physiotherapists when making treatment decisions for acute LBP. A synthesis of current clinical guideline recommendations provides physiotherapists with readily interpretable guidance for the management of acute LBP and encourages the uptake of best-evidence treatment options.
Background: This paper reports on the effectiveness of a checklist that assists patients to transition safely and sustainably from hospital to home. Methods: Medical wards in three tertiary public hospitals in metropolitan Adelaide provided subjects during 2004. Eligible patients were English-literate and aged at least 60 years, provided written informed consent and had an unplanned hospital admission for a new medical condition. Data was excluded post-hoc if subjects had another hospital readmission for the same condition within seven days of discharge. The study had a quasi-experimental study design in which each hospital acted as its own control. In each hospital, the first half of the study period measured the outcome of usual discharge planning practices (control phase), and the second half of the study period measured the outcome following administration of the checklist (intervention). Quantitative and qualitative (grounded theory) evaluation methods were used. Results: 464 potentially eligible patients were approached and 317 (63.3%) consented to participate (210 control and 107 intervention subjects). Post-hoc exclusion and loss to follow-up reflected 60% (control) and 42% (intervention) subjects. Unplanned readmission to hospital (post hoc exclusion) reflected 21% control and 39% intervention phase subjects. A key reason for loss to follow-up was inability to contact subjects seven days after discharge (29% control, 16% intervention phases). Complete outcome data was collected from 148 subjects. For patients with family/ friends who visited them in hospital, the checklist provided the opportunity for joint discussion and decision-making prior to discharge about daily living activities. These activities were often additional to formal discharge plans. The short duration of hospital admission, and generally poor health precluded many patients without family/ friends from obtaining maximum benefit from the checklist. Conclusion: The checklist improved patients’ preparedness for discharge, particularly when family/ friends were involved.
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